BMC Health Services Research最新文献

{"title":"Evaluation of comprehensive abortion care service in University of Gondar Comprehensive Specialized Hospital in Northwest Ethiopia: mixed case study design.","authors":"Birtukan Demis Getaneh, Nigusu Worku, Kaleb Assegid Demissie, Tesfahun Zemene Tafere, Melak Jejaw","doi":"10.1186/s12913-025-12579-y","DOIUrl":"10.1186/s12913-025-12579-y","url":null,"abstract":"<p><p>Despite Ethiopia's substantial progress in comprehensive abortion care, the consequences of abortion remain a major public health challenge. This study aimed to assess the implementation status and its determinants of comprehensive abortion care service at University of Gondar Comprehensive Specialized Hospital. A facility-based single case study with convergent parallel mixed-method evaluation was conducted from March 28 to April 28, 2023. Availability, patient-centered care, timeliness, and compliance dimensions with 35 indicators were used. A total of 379 exit interviews, five key informant interviews, six in-depth interviews, 411 medical charts reviewed, and 17 observations were done. Stata version 17 was used. Binary logistic regression analysis was computed to identify eligible variables for the multivariable logistic regression, and a variable with p-value < 0.05 at adjusted odds ratio with a 95% confidence interval was declared as statistically significant. The qualitative data were recorded through a tape recorder, transcribed in Amharic and translated to English, and analyzed thematically.The overall implementation status of comprehensive abortion care (CAC) was found to be 65.1%, which is considered fair according to judgment parameters. Availability of CAC resources, compliance of service providers, timeliness, and patient-centered care contributed scores of 85.7% (very good), 72.6% (fair), 40.6% (poor), and 61.3% (fair), respectively. Urban dwellers, married women, had family support, privacy to access abortion care, and those who communicated on medication were positive predictors of patient-centered care. There were stock outs of essential emergency drugs, shortages of equipment and trained manpower, and poor infrastructure. Besides, none of the providers comply with hand washing protocols and used personal protective equipment, and there were delays in providing abortion services. The overall CAC program service implementation needs urgent improvements, especially in timeliness, which was notably poor and needs major enhancements. Thus, to improve CAC services, the hospital should ensure the availability of essential drugs, equipment, and infrastructure. The Ministry of health should improver providers' compliance with CAC guidelines by providing training and enhancing continuous professional development programs. Moreover, policymakers and planners should focus on enhancing providers' communication skills and family involvement in care decisions, and warranting patient privacy and confidentiality according to established protocols.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"449"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the implementation of an insulin patient decision aid for patients with type 2 diabetes in an academic primary care clinic in Malaysia: a mixed method study.","authors":"Wen Ting Tong, Chirk Jenn Ng, Yew Kong Lee, Ping Yein Lee","doi":"10.1186/s12913-025-12588-x","DOIUrl":"10.1186/s12913-025-12588-x","url":null,"abstract":"<p><strong>Background: </strong>Literature surrounding patient decision aid (PDA) focus on testing effectiveness such as measuring patient or practice outcomes, while few studies looked into evaluation of implementation outcomes. It is important to assess implementation outcomes because in order for PDA to deliver its intended effects, they should first be effectively implemented. This study aimed to evaluate the implementation of an insulin PDA in an academic primary care clinic specifically measuring implementation outcomes.</p><p><strong>Methods: </strong>A mixed-methods sequential explanatory design was used. This study was conducted at a primary care clinic in an academic hospital from April - November 2018. The insulin PDA was implemented using a tailored implementation intervention, which comprised of 11 strategies aiming to overcome 13 prioritised implementation barriers. Evaluation data were collected from: healthcare administrators such as the head of department, the clinic coordinator, and the nursing officer who oversees the clinic operations, doctors whose tasks were to deliver the insulin PDA to patients, nurses who were responsible for making sure the insulin PDAs were available, and patients with type 2 diabetes who were offered the insulin PDA. The study commenced with the quantitative approach to assess 'Reach', 'Adoption', 'Implementation' and 'Maintenance'of the insulin PDA. Subsequently, qualitative approach was employed and qualitative interviews were conducted with the relevant stakeholders to explain the quantitative outcomes. A total of six IDIs and six FGDs were conducted with healthcare providers (healthcare policymakers: 3, doctors: 35, and staff nurses: 5), and 62 IDIs were conducted with patients.</p><p><strong>Results: </strong>For 'Reach', 88.9% (n = 48/54) of doctors and 55% (n = 11/20) of nurses attended the insulin PDA training workshops. This was attributed to their self-motivation and the mandate from the Head of Department. The PDA reached 387 patients and was facilitated by the doctors who delivered the PDA to them and their own desire to know more about insulin. Doctors' 'Adoption' of the PDA was high (83.3%, n = 45/54) due to the positive personal experience with the usefulness of the PDA. Only 65.7% (n = 94/143) of patients who received the PDA read it. The degree of 'Implementation' of the PDA varied for different tasks (ranged from 19.2 to 84.9%) and was challenged by patient and system barriers. For 'Maintenance', 80% of the doctors were willing to continue using the PDA due to its benefits.</p><p><strong>Conclusion: </strong>This study highlighted that the implementation of an insulin PDA in a primary care setting is promising. Addressing the issues of social hierarchy, and healthcare providers' roles and responsibilities can further improve implementation outcomes.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"450"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change of primary health care service provider model in Vantaa: the impact on mortality and causes of death among older adults - a register-based follow-up study.","authors":"Aina Enckell, Hanna-Maria Roitto, Hannu Kautiainen, Mika T Lehto, Kaisu H Pitkälä, Timo Kauppila, Merja K Laine","doi":"10.1186/s12913-025-12595-y","DOIUrl":"10.1186/s12913-025-12595-y","url":null,"abstract":"<p><strong>Background: </strong>Access to primary health care (PHC) has declined in Finland in recent years. To address this, the city of Vantaa, Finland, transitioned from a named general practitioner (GP) model to a restricted-list GP model in 2011 to increase access to named GPs for the most vulnerable population. This study evaluates the impact of this model change on mortality rates and causes of death among older adults.</p><p><strong>Methods: </strong>This register-based follow-up study was conducted in Vantaa, Finland, using data from the electronic health records. The study included all patient contacts aged 75 and older between 1 September 2004 and 31 August 2018. The primary outcome was the Standardised Mortality Ratio (SMR). We calculated excess deaths and examined cause-specific mortality trends before and after the restricted-list GP model implementation.</p><p><strong>Results: </strong>During the study period, 32,034 PHC contacts were recorded. The SMR remained stable during the named GP model years but began to decrease during the restricted-list GP model, falling below expected levels from 2016 onward. Excess deaths decreased from 615 in 2004 in the named GP model to -29 by 2018, when the restricted-list GP model was in operation. Leading causes of death were circulatory diseases (41.1%), cancers (20.4%) and neurological conditions (17.8%), with a decrease in circulatory disease deaths and an increase in cancer and dementia-related deaths over time.</p><p><strong>Conclusions: </strong>The transition to the restricted-list GP model was associated with a lower SMR and fewer excess deaths in older adults. These findings highlight the importance of ongoing assessment of PHC models to ensure they meet evolving healthcare demands.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"458"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Raising awareness and preparation for what may come: next of kin experiences of advance care planning with frail, home-dwelling older adults in geriatric units.","authors":"Karin Berg Hermansen, Rigmor Einang Alnes, Trygve Johannes Lereim Saevareid, Reidar Pedersen, Siri Faerden Westbye, Maria Romøren, May Helen Midtbust","doi":"10.1186/s12913-025-12609-9","DOIUrl":"10.1186/s12913-025-12609-9","url":null,"abstract":"<p><strong>Background: </strong>Acutely ill and frail older adults and their next of kin are often poorly involved in planning of decisions regarding treatment and care during the final phase of life. Although advance care planning is a well-documented tool to strengthen patient autonomy and involve next of kin, it remains underused in hospital settings. We present a qualitative sub-study embedded in a cluster-randomized controlled trial, whose purpose was to implement advance care planning in Norwegian geriatric units. Frail, home dwelling older adults acutely admitted to geriatric hospital units were invited to participate in advance care planning together with their next of kin. The aim of this study was to explore next of kin experiences of advance care planning.</p><p><strong>Methods: </strong>The study has a qualitative design, based on individual semi-structured interviews with 13 next of kin. A purposive sampling was used to select next of kin who had recently participated in advance care planning from five geriatric units in the intervention arm. The analysis was conducted using reflexive thematic analysis by Braun and Clarke.</p><p><strong>Results: </strong>Four themes were developed from the analysis; (1) Being informed and involved through open communication; (2) Getting prepared for what's to come; (3) The importance of the next of kin role in providing support and facilitation; (4) The need for documentation and collaboration across service levels.</p><p><strong>Conclusion: </strong>Advance care planning appears to provide a sense of security among next of kin by addressing their information needs regarding the patient's prognosis, encouraging discussions on possible courses of action, and clarifying the patient's end-of-life preferences. Next of kin played a crucial role in supporting the patient's autonomy, and they considered the hospital stay as an ideal time for advance care planning. Increased awareness of their role as next of kin seems to enhance agreement and trust when confronting challenging situations and existential questions.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier NTCT05681585. Registered 03.01.23.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"454"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The extent to which medical specialists provide Clinical Work-Integrating Care (CWIC) and their perceived role-responsibility: a mixed-methods study.","authors":"Lana Kluit, Astrid de Wind, Annechien Beumer, Coen A M van Bennekom, Angela G E M de Boer","doi":"10.1186/s12913-024-12137-y","DOIUrl":"10.1186/s12913-024-12137-y","url":null,"abstract":"<p><strong>Background: </strong>Awareness among medical specialists about patient work concerns is important because work and health are linked. In Clinical Work-Integrating Care (CWIC), specialists adopt the notion that work can affect health, and medical actions can affect work participation, and they act according to that notion. This study aims to assess the extent to which specialists provide CWIC and to obtain perceptions of medical specialists about their professional role-responsibility in providing CWIC.</p><p><strong>Methods: </strong>This cross-sectional mixed-methods study involved quantitative questionnaires and qualitative interviews with medical specialists. The self-developed 18-item questionnaire evaluated the extent and type of CWIC provision (rating scale 0-4; Never = 0 to Always = 4) and how role-responsibility was perceived, while the interviews offered more in-depth insights. Descriptive statistics for the questionnaire data and thematic analyses for the interview data were applied.</p><p><strong>Results: </strong>We attained 160 questionnaires (female 64%, 93% non-surgical specialists) and 11 interviews (female 64%, 91% non-surgical specialists). Specialists often asked patients about work (mean score 3.1), sometimes about work history (mean score 2.2) and the conversation about work was usually started by the specialist (mean score 2.9). Conversations about work often concerned the influence of work on disease (2.4) and the influence of disease (2.5) or treatment (2.1) on work ability, but rarely about the legal aspects related to sick leave (1.5). The specialists' perceived role-responsibility was summarized in three themes: 1) understanding that work and health (problems) are linked including asking patients about work and investigating work factors, 2) supporting work participation within a specialist's expertise including focus on patients' health and prevention of sick leave, and 3) possibilities and limitations of the healthcare system including work participation as treatment goal and cooperation with occupational health care.</p><p><strong>Conclusions: </strong>Medical specialists in our survey usually asked about patients' work, but they often did not take a work history. Limitations within the healthcare system hinder comprehensive work-integrating support by specialists, defining the boundaries of CWIC to within hospital care.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"448"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative study of neuro-fuzzy and neural network models in predicting length of stay in university hospital.","authors":"Birgül Yabana Kiremit, Elif Dikmetaş Yardan","doi":"10.1186/s12913-025-12623-x","DOIUrl":"10.1186/s12913-025-12623-x","url":null,"abstract":"<p><strong>Background: </strong>The time a patient spends in the hospital from admission to discharge is known as the length of stay (LOS). Predicting LOS is crucial for enhancing patient care, managing hospital resources, and optimizing the use of patient beds. Therefore, this study aimed to predict the LOS for patients hospitalized in various clinics using different artificial intelligence (AI) models.</p><p><strong>Methods: </strong>The study analyzed 162,140 hospitalized patients aged 18 and older at various clinics of a university hospital in northern Türkiye from 2012 to 2020. Three soft computing methods-Artificial Neural Networks (ANN), Adaptive Neuro-Fuzzy Inference Systems (ANFIS), and Multiple Linear Regression Analysis (MLR)-were employed to estimate LOS using inputs such as medical and imaging services (number of CT, USG, ECG, hemogram tests, medical biochemistry, and number of direct x-rays), demographic, and diagnostic data (patients' age, sex, season of hospitalization, type of hospitalization, diagnosis, and second diagnosis). The LOS predictions utilized single and double-hidden layer ANNs with various training algorithms (Levenberg-Marquardt-LM, Bayesian Regularization-BR and Scaled Conjugate Gradient-SCG) and activation functions (tangent-sigmoid, purelin), ANFIS with Grid Partitioning (ANFIS-GP), and MLR. Model performance was evaluated using the Coefficient of Determination (R²), Root Mean Square Error (RMSE) and Mean Absolute Error (MAE).</p><p><strong>Results: </strong>Of the patients, 54% were male and 43.5% were treated in surgical clinics. The mean age was 55.1 years, with 32.9% of participants aged 65 years or older. Hospital stays were 2-7 days for 39.7% of patients, over 7 days for 30.9%, and 1 day for 29.4%. Neoplasm-related diagnoses (ICD codes) accounted for 25.1% of admissions. Variables influencing LOS were identified through feature selection from patients in various hospital wards. The most significant factors affecting LOS include second diagnosis, the number of hemogram tests, computerized tomography scans (CT), ultrasonography (USG), and direct X-rays. Utilizing these factors, 12 models with varied input variables were developed and analyzed. The double hidden layer ANN model with the Levenberg-Marquardt (LM) training algorithm outperformed the others, achieving R² values of 0.854 for training and 0.807 for the test dataset, with RMSE values of 2.397 days and 2.774 days and MAE values of 1.787 days and 1.994 days, respectively. Following ANN-LM, the best results were obtained with ANFIS-GP, while MLR exhibited the lowest performance.</p><p><strong>Conclusions: </strong>Various AI models can effectively predict LOS for patients in different hospital units. Accurate LOS predictions can help health managers allocate resources more equitably across units.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"446"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative study of nurses' competencies in integrating religion/spirituality into patient care.","authors":"Jamileh Farokhzadian, Amirreza Sabzi, Zakieh Farmitani","doi":"10.1186/s12913-025-12613-z","DOIUrl":"10.1186/s12913-025-12613-z","url":null,"abstract":"<p><strong>Background: </strong>There is a need of research to evaluate and compare the competencies of nurses in integrating patients' religion and spirituality into nursing practice in various settings, including general and psychiatric hospitals. By understanding the competencies of nurses working in different environments, tailored spiritual care training programs can be developed to meet their specific needs. This study aimed to evaluate and compare the competencies of nurses in integrating patients' religion/spirituality into nursing practice in both a general and a psychiatric hospital.</p><p><strong>Methods: </strong>This cross-sectional descriptive-analytical study was conducted in two hospitals affiliated with Kerman University of Medical Sciences in southeastern Iran. Quota sampling was used to select 200 nurses (100 nurses from each hospital) in 2023. The Religious/Spiritually Integrated Practice Assessment Scale (RSIPAS) was used to evaluate and compare nurses' competencies in integrating the religion/spirituality of patients into their nursing practice.</p><p><strong>Results: </strong>The study revealed that nurses' competencies in integrating patients' religion/spirituality into nursing practice were moderate in both general (122.39 ± 19.40) and psychiatric hospitals (110.82 ± 25.63). Nurses in the general hospital had significantly higher competency scores compared to those in the psychiatric hospital (t = 3.59, p = 0.001). The type of hospital, work experience, and the involvement of professionals in providing religion/spirituality care were significant predictors of nurses' competencies in integrating patients' religion/spirituality into clinical practice.</p><p><strong>Conclusions: </strong>The moderate levels of competencies among nurses highlight the need for further education and training to effectively integrate patients' religion/spirituality into nursing across various healthcare settings. The type of hospital also influenced their competencies. Therefore, it is crucial for nurses, particularly those working in psychiatric hospitals, to receive training that is tailored to the specific needs, culture, and context of their respective healthcare environments. It is essential to conduct a baseline assessment of nurses' readiness and competencies before implementing appropriate training programs.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"447"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Income-related benefit mobility before and after Urban and Rural Resident Basic Medical Insurance integration: a longitudinal analysis of China.","authors":"Yongjian Xu, Yazhuo Liu, Hui Li, Ruirui Guo, Jiaxin Sun, Zhongliang Zhou, Jie Ma","doi":"10.1186/s12913-025-12574-3","DOIUrl":"10.1186/s12913-025-12574-3","url":null,"abstract":"<p><strong>Background: </strong>To improve equity in medical insurance benefits, the Chinese government integrated the New Rural Cooperative Medical Scheme for rural residents and the Urban Resident Basic Medical Insurance for nonworking urban residents into a unified Urban and Rural Resident Basic Medical Insurance system (URRBMI). This study aims to assess income-related mobility in medical insurance benefits before and after the integration of the two schemes, and to explore its contribution to improving medical insurance equity.</p><p><strong>Methods: </strong>The panel data were obtained from the 2011 and 2018 China Health and Retirement Longitudinal Study, with 9,662 participants. To assess the benefits residents received from medical insurance, four indicators were analyzed for outpatient and inpatient care respectively: benefit rate, benefit probability, compensation fee, and reimbursement probability. The concentration index (CI) was used to measure the income-related inequality of medical insurance benefits. Changes in inequality across the two waves were decomposed into income-related benefit mobility and benefit-related income mobility, which reflect variations in relative benefit changes among individuals with different initial income levels, capturing the effect of integration on benefit inequality.</p><p><strong>Results: </strong>Results indicated a significant increase in all medical insurance benefit measures following integration, except for outpatient care benefit probability and inpatient care reimbursement probability. The CIs shifted from positive in 2011 to negative in 2018 (0.129 vs. -0.052 for the benefit rate, 0.147 vs. -0.044 for the benefit probability, and 0.148 vs. -0.097 for the reimbursement probability, p < 0.001). The income-related mobility for inpatient care (benefit rate, benefit probability, and compensation amount) were positive when the average benefit level increased across the two waves. In contrast, no statistically significant difference was observed in outpatient benefit mobility.</p><p><strong>Conclusions: </strong>The findings indicated that income-related inequalities in medical insurance benefits were narrowed due to pro-poor changes in inpatient care equity for inpatient care after integration. This integration has contributed to building a more equitable healthcare system. However, further efforts are needed to expand outpatient benefit coverage in the integrated URRBMI scheme.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"456"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clients' experiences of receiving service navigation for mental health support in primary care: findings from a mixed-methods evaluation.","authors":"Megan Rattray, Tania Shelby-James","doi":"10.1186/s12913-025-12622-y","DOIUrl":"10.1186/s12913-025-12622-y","url":null,"abstract":"<p><strong>Background: </strong>The 'Service Navigation Measure' (SNM) initiative was introduced in 2020 as part of Commonwealth Psychosocial supports delivered through the Primary Health Networks (PHNs) in Australia. The aim of this study was to explore the experiences of clients who received this initiative.</p><p><strong>Methods: </strong>An exploratory sequential mixed method study was undertaken in the Australian primary care setting. Quantitative data, which involved closed-ended questions, were collected via a survey. Qualitative data were then collected through open-ended questions in the survey and during one-on-one, semi-structured interviews. This data was collected from clients (consumers, families, carers, and health practitioners) who accessed the service one or more times for mental health support. Interviews were audio recorded and transcribed verbatim. Methodological triangulation was employed to enhance the validity and credibility of the findings. This involved thematically analysing the qualitative data to identify emergent themes and sub-themes, and aligning the quantitative data, which were summarised using frequency (%), to these findings where appropriate.</p><p><strong>Results: </strong>A total of 349 clients (159 consumers, 43 family members, 70 carers or support workers, 72 health practitioners, 7 unknown) completed the survey and 8 of these participated in a follow-up interview (7 consumers and 1 health practitioner). Three overarching themes emerged from the data: (i) Receiving helpful and timely support, (ii) Appreciating empathetic and understanding support, and (iii) Valuing and enhancing follow-up support.</p><p><strong>Conclusions: </strong>Clients expressed overwhelmingly positive experiences, attributing their satisfaction to timely, helpful, and empathetic support, as well as the vital role of follow-up care. This appreciation extended not only to individuals facing mental health challenges but also to the carers and healthcare practitioners seeking information for those under their care. By incorporating these insights into service navigation practices, healthcare systems may enhance their ability to address the mental health needs of their communities, potentially contributing to improved experiences and outcomes for individuals facing mental health challenges.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"445"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring trauma-informed prenatal care preferences through diverse pregnant voices.","authors":"Mohammad S Itani, Megha Shankar, Ellen Goldstein","doi":"10.1186/s12913-025-12519-w","DOIUrl":"10.1186/s12913-025-12519-w","url":null,"abstract":"<p><strong>Background: </strong>There are no existing standards of care for integrating trauma-informed care into prenatal care in a patient-centered manner. This study aims to explore preferences of pregnant people regarding prenatal care, prenatal providers, resources, and trauma inquiry and response.</p><p><strong>Methods: </strong>This study utilized a qualitative descriptive design as part of a longitudinal randomized controlled pilot trial. It was conducted at a university-affiliated federally qualified health center and multi-specialty clinic in a large metropolitan area among a purposive sample of 27 racially/ethnically diverse pregnant individuals. Eligible participants aged ≥ 18 between 10 and 24 weeks gestation were identified via medical charts and recruited in person and by email. Interview-administered structured interviews were provided at the post-intervention assessment. Qualitative data collection extended from June 2023 through April 2024. We performed inductive analysis to generate codes and identify emergent themes derived from participant responses. Participant preferences for prenatal care were interpreted through the lens of the six trauma-informed care principles.</p><p><strong>Results: </strong>Participants had an average age of (M = 28, SD = 4.5; range = 19-38) years old. Of the 27 participants interviewed, 21 self-identified as Black (77.8%) and 5 as Hispanic (18.5%). Three themes identified optimal prenatal care preferences, including: (1) Agency and Choice; (2) Emphasis on Maternal and Child health and Wellbeing; and (3) Universal and Personalized Provision of Information and Resources. Participants wanted their providers to be Familiar and Experienced; Personally Engaging; and Emotionally Safe and Supportive. Three additional themes focused on patient preferences for addressing trauma during prenatal visits, including: (1) Value of Addressing Trauma; (2) Approaches to Asking about Trauma; and (3) Sensitive and Empathic Inquiry and Response.</p><p><strong>Conclusions: </strong>Patient preferences identified by this study underscore the need for prenatal care to address the psychological health needs of pregnant patients to deliver high quality, comprehensive prenatal care that is trauma-informed and culturally-responsive.</p><p><strong>Trial registration: </strong>This study was registered at ClinicalTrials.gov ID: NCT05718479 on 08-02-2023.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"452"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}